Pathological methods applied to the investigation of causes of death in developing countries: minimally invasive autopsy approach

Abstract

Background and AimsComplete diagnostic autopsies (CDA) remain the gold standard in the determination ofcause of death (CoD). However, performing CDAs in developing countries is challengingdue to limited facilities and human resources, and poor acceptability. We aimed to developand test a simplified minimally invasive autopsy (MIA) procedure involving organ-directedsampling with microbiology and pathology analyses implementable by trained techniciansin low- income settings.Methods

A standardized scheme for the MIA has been developed and tested in a series of 30 autopsies performed at the Maputo Central Hospital, Mozambique. The procedure involves the collection of 20 mL of blood and cerebrospinal fluid (CSF) and puncture of liver, lungs, heart, spleen, kidneys, bone marrow and brain in all cases plus uterus in women of childbearing age, using biopsy needles. Results

The sampling success ranged from 67% for the kidney to 100% for blood, CSF, lung, liver and brain. The amount of tissue obtained in the procedure varied from less than 10 mm2 for the lung, spleen and kidney, to over 35 mm2 for the liver and brain. A CoD was identified in the histological and/or the microbiological analysis in 83% of the MIAs. Conclusions

A simplified MIA technique allows obtaining adequate material from body fluids and major organs leading to accurate diagnoses. This procedure could improve the determination of CoD in developing countries.